TRANSITION OF CARE PROTOCOL FROM EMERGENCY DEPARTMENT TO STONE CLINIC IMPROVES NON-OPERATIVE MANAGEMENT
Patients in distress are less likely to attempt ureteral stone passage. We introduced a standardized transition of care protocol from Emergency Department to stone clinic in attempt to improve patient status at time of consultation and report outcomes over time.
All patients referred to subspecialty stone clinic were identified. A standardized transition of care protocol was developed and promoted. The protocol included: subspecialty stone clinic referral; patient discharge instruction emphasizing non-narcotic symptom control; a next-day stone clinic nurse triage call; and expedited clinic access. Shared decision-making regarding trial of stone passage occurred at initial clinic encounter. PROMIS® pain intensity was recorded preceding provider contact (score of 60 represents 1 standard deviation above population mean). Inclusion criteria: uninfected, unilateral, <10 mm, ureteral stones. Primary outcome was surgery within 90 days.</p>
Three phases of operationalization were considered: development (DP, n=278); implementation (IP, n=316); and consolidation (CP, n=306). Univariate analysis demonstrates no difference in demographic factors and progressive improvement in protocol initiation, pain, and stone passage parameters (Table 1, Figure 1). Multivariable analysis demonstrated that initial pain score had the largest effect on decision to attempt stone passage and overall likelihood of stone surgery (Table 2). Protocol initiation was associated with decreased failure of attempted stone passage.
Introduction of a standardized transition of care protocol from ED to stone clinic improved all parameters of non-operative stone management.